Heel pain: causes and treatments

Heel pain affects around one-in-10 people at some point in their lifetime – and it can be very painful. The cause in around 80 per cent of cases is plantar fasciitis, arising from damage to the band of tissue connecting the heel bone with the rest of the foot. The tissue acts as a kind of shock absorber for your foot, and this condition sees it thickening and micro-tears developing in it – which is where the pain comes from.

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What causes plantar fasciitis?
Very generally, plantar fasciitis tends to affect two groups of people – young, active people who might suffer sudden damage from running or dancing and people over 40 with gradual wear-and-tear injuries. Risk factors include being overweight or obese, spending a long time standing up and wearing flat-soled shoes – including sandals and flip-flops.

How is it treated?
Doctors advise waiting until you've had persistent heel pain for a few weeks before seeing a doctor or podiatrist, as the condition can sometimes clear up by itself relatively swiftly. Most cases of heel pain get better within a year, with rest and painkillers usually prescribed in the short term.

Rest doesn't mean putting your feet up 24/7, but rather avoiding walking long distances or standing for a long time. Non-steroidal anti-inflammatory drugs such as ibuprofen have been found to work well for the condition. In the longer term, exercises are the most-common means of overcoming the condition, with only one-in-20 sufferers having to resort to surgery.

What exercises are advised?
The NHS Choices website suggests a number of simple exercises to strengthen the calf muscles and the plantar fascia.

Towel stretches
Laying down, loop a towel around your foot and pull your toes towards you with your knee straight. Repeat three times for each foot.

Wall stretches
Press both hands to a wall at shoulder height, placing one foot in front of the other, about 30cm from the wall. Bend your front knee and keep your back knee straight as you lean towards to wall so your calf muscle will tighten. Relax and repeat 10 times before switching legs. Do this twice a day.

Chair stretches
Sit with knees bent at right angles and toes pointing outwards away from one another. Lift the toes of the affected foot, with the heel firmly on the floor – your Achilles tendon and calf muscle will tighten so hold that for a few seconds and repeat 10 times. Do this five or six times a day.

Stair stretches
Stand on a step, holding a bannister rail for support. Position your heel off the back of the step and lower your heels until you feel the calf muscles tighten. Hold for forty seconds and repeat six times, two or three times a day.

Dynamic stretches
While seated, roll the arch of your foot over a round object like a tennis ball or full soft drink can. Move your foot in all directions over it for several minutes, repeating a few times a day. Some patients find that using a can of chilled drink can also provide pain relief.

Other relief
A change of footwear is often advised, with flat-soled shoes a no-no and heel and arch support recommended. While not a long-term solution, high heeled shoes or heeled boots and brogues have been found to lessen the pressure on the heel.

Orthoses, also known as insoles, can be used to replace the standard insoles in sufferers' shoes. These can offer much-improved foot support and are available off-the-shelf or custom-made. A similar support effect can be achieved with sports strapping tape, although it's best to learn the correct technique from a podiatrist. If none of the above is working, doctors can prescribe corticosteroid injections, which have a powerful anti-inflammatory effect. These are generally limited to three a year, due to side effects.

Surgery
If you are still suffering after a year, you may be referred to an orthopaedic or podiatric surgeon, who will cut the fascia to release it for your heel bone – reducing inflammation and relieving pain. This can be carried out either as open survey or endoscopic surgery (often called keyhole surgery), and each method has pros and cons. Your GP or specialist should be able to advise on your particular case.

Other causes
For the 20 per cent of heel pain sufferers who don't have plantar fasciitis there are a number of possible ailments. A stress fracture to the heel bone is one possibility, while "fat pad atrophy" is another. The latter condition sees the layer of fat under the heel bone waste away under pressure. It is often observed in people who often wear high heels. Bursitis, tarsal tunnel syndrome and Sever's disease are other less-common causes; the latter being most-common in children.